Vitamins and supplement

‘Supplement’ is a broad term

Supplements are often referred to as ‘food supplements’, ‘nutritional supplements’ and ‘dietary supplements’. As yet, there is no universally agreed definition, and definitions vary from country to country.

Exactly what supplements can contain also vary, ranging from a single vitamin or mineral to a long list of vitamins, minerals, herbs, amino acids, fibre, plant compounds and much more. You can buy two seemingly similar supplements of a nutrient that may vary by the form of the nutrient, the level of the nutrient and the range of other nutrients combined to improve the uptake, and of course by cost and dose. Let’s take vitamin C for example: you can purchase it as ascorbic acid (straight vitamin C), or ascorbic acid mixed with buffers to make it easier on the stomach (and cheaper, supposedly) such as sodium (sodium ascorbate) or calcium (calcium ascorbate), you can also get vitamin C with bioflavonoids and so on. Needless to say, this seemingly endless range of options doesn’t make it easy to select what is best for you and your family.

It is easy to make the assumption that supplements are harmless because much of what is in a supplement is found in food. However, no laboratory has yet equalled Mother Nature in the way she packages nutrients, which makes food our best source of nutrition.

Who needs a supplement?

For whatever reason, some of us are more likely to require a certain dietary supplements. For example:

Pregnant women and women who are planning to conceive need will benefit from taking folic acid. Folic acid is best taken prior to getting pregnant and continued for some months it can significantly reduce the risk of neural tube defects in babies.
Women who are breastfeeding their infants are often recommended a supplement, particularly if they are young mothers or have had pregnancies in rapid succession.
Cigarette smokers and people, who drink alcohol, often require increased nutrients.
Drug users may also be recommended nutrient supplements for a number of reasons, including poor diet.
People who are on low-calorie diets or who restrict their diet for some reason, e.g. lactose intolerance or an allergy, may need a supplement.
The frail and the elderly as well as people who are very ill, often need supplements because of a poor diet.
People who are inactive, not able to get outdoors or people who cover the majority of their bodies, are commonly recommended vitamin D.
Individuals with malabsorptive disorders such as celiac disease are recommended supplements to counteract the loss of nutrients.

If you fall into any one of these categories it is best to talk with your healthcare professional or doctor about a supplement before you go out and buy something that may not be suitable for you.

Common nutrient concerns

Folic acid

As mentioned above, women planning a pregnancy or in the early stages of their pregnancy, generally require folic acid supplementation. Interestingly though, this it is not due to a deficiency but rather a processing issue. Supplementation simply provides more folic acid to ‘push’ into the maternal system to overcome any potential error in processing folate.

Iodine

There is evidence that women and children are at greater risk of an iodine deficiency, which is why iodine fortification programmes are commencing in many countries and why standard pregnancy supplements now include iodine. Which is why in South Africa, all table salt has a mandatory 40-60 ppm iodine added to it and we have an optimal iodine nutritional status since 1998. However, iodine must not be taken in excess as it may have detrimental effects.

Calcium

There is some concern for adolescent girls, many of whom don’t seem to be getting adequate calcium. The adolescent stage appears to be an important stage of bone density formation - hence calcium intake is critical.

Vitamin D

Vitamin D is also considered a nutrient of concern particularly in children, the elderly and those who aren’t exposed to enough sunlight. Look out for labels reading “with added vitamin D” to put into your trolley.

Are dietary supplements safe?

Not all herbs and supplements are safe. If you are unsure about the safety of a supplement or herb, talk to your doctor, pharmacist, or healthcare professional.Always tell your doctor if you are using a dietary supplement or if you are thinking about combining a dietary supplement with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on a dietary supplement. This is especially important for women who are pregnant or breast-feeding.When using dietary supplements, keep in mind the following:

They may cause side effects, trigger allergic reactions, or interact with prescription and non-prescription medicines or other supplements you might be taking. This may make your other health conditions worse.
The way dietary supplements are manufactured may not be standardised. Because of this, how well they work or any side effects they cause may differ among brands or even within different lots of the same brand. The form of supplement that you buy in health food or grocery stores may not be the same as the form used in research.
Other than for vitamins and minerals, the long-term effects of most dietary supplements are not known.

Arguments against nutrient supplementation

A number of arguments have been levelled against the regular use of nutritional supplements without confirmed requirement. These include:

Taking a supplement may give us a false sense of security preventing people from maintaining a healthy diet and lifestyle.
Supplement marketing and advertising can be misleading and confusing to consumers given the complex nature of nutrients.
Nutrients interact constantly with each other. To date, it isn’t clear to what extent a supplement may interfere with our body’s nutrient balances.
Nutrients can both help and hinder. For example, vitamin E may reduce the risk of cardiovascular disease, but may increase the risk of stroke.
Excessive intake of certain nutrients can be toxic and/or lead to other nutrient deficiencies or mask existing nutrient deficiencies.
Some nutrient supplements have been found to interfere with medications.
Results from research into supplements are difficult to evaluate. One reason being that supplements come in a huge variety of combinations.
Many are expensive.

What about using supplements to protect against cancer?

Few of us aren’t touched by cancer and there can be a tendency to believe that taking a supplement may protect us against cancer. However, most agencies don’t support the consumption of supplements to prevent cancer and other illnesses, suggesting that high-dose nutrient supplements, while they can protect against some cancers, may also be linked to others. Increasing your intake of nutrient-dense foods and beverages is the recommendation by most organisations.

Why not use food as our medicine?

The health benefits inherent in our plant foods, such as herbs from the garden or even supermarket, are often overlooked. For example, there is some great information coming to light about turmeric, commonly used in Indian cuisine, with regard to its benefits in food (over supplementation) in relation to cancer prevention. Numerous cancer societies note research conducted on foods and their preventative action against cancer.

A few examples of foods believed to reduce your cancer risk include:

Broccoli
Garlic
Vitamin C-rich foods such as red capsicum, guava, acerola, etc.
Fish oils and plant oils such like those found in salmon or flaxseed and chia seeds.
Probiotics and their link to improved immunity and intestinal health.

Be a discerning consumer

Whether you choose to use supplements or believe your child needs a supplement consider taking a targeted approach:

Have your diet or your child’s diet assessed by a dietician or qualified healthcare professional.
Assess how the resulting nutrient levels compare to the appropriate Recommended Daily Intake (RDI).
Discuss these results and your or your child’s overall health with a dietician or qualified healthcare professional and let them help you develop a diet that supplements your nutritional needs, based on this.
Ensure you have this diet updated regularly as life changes constantly.

Food first!

There is an extensive amount of research showing that the nutrients packaged in our food have a far more beneficial effect than synthetically made nutrients (folic acid appears to be the exception, with a greater absorbency than natural folate). In fact, a number of isolated nutrients appear to have different effects when they exist in a food. This may be due to the other nutrients and their levels inherent in a food, or even the nutrient compounds that are added to supplements.

We are still discovering new compounds in food, and uncovering the effects and benefits of many of the nutrients we already know of and how they work together. While there is some consensus that supplements have their place, better formulated supplements for specific users is needed. By far the best protector against disease and ill-health is a varied diet of healthy foods along with an appropriate level of activity.